Wednesday, November 7, 2012

Re: Apocalypse Pharmaka, Part Deux.

Deus ex Machina

When I was in my
sophomore year of college I made a classic mistake: I began reading
literature put out by the anti-Psychiatrists.
If you want to undermine your faith in any given field, and their
narrative of success, just look into the works of the dissidents. The
primary concern of the anti-Psychiatrists was that Psychiatry was
being used as a tool for control of the populace, rather than helping
make adjustments that would benefit the mentally ill and allow them to lead healthier lives.

Their stance
exploded into view following a report
in Science entitled “On
Being Sane in Insane Places” that undermined the entire field of
both psychology and psychiatry: the Rosenhan
Experiment. What happened, in brief, was this:

Rosenhan
and several participants went to several institutions (around
twelve), and told those involved that they heard a voice (auditory
hallucination). The voice, which was always the same gender as the
participant, didn't say much except for the following words:
“hollow,” “empty,” and “thud.” Everyone was diagnosed as
schizaphrenic or another diagnosis along those lines, and Rosenhan
himself had to spend two months institutionalized, even though once
admitted all participants claimed immediate relief. The catch was
this: none of them were insane, and they were all faking their
symptoms.

Upon
returning to the world of the “sane,” Rosenhan revealed what he'd
done. Institutions immediately began challenging him to try it again,
and Rosenhan seemed to agree. Within a month he began receiving
details: around 193 patients were considered to be his, with at least
42 considered suspect. In reality, this time Rosenhan had sent
no-one.

The
effect on the Psychological and Psychiatric communities was one of
melt-down. The entire premise of their diagnoses were now suspect,
and a glaring error was exploding into the light. In response the DSM volumes began to be produced.

“Ahha!”
Said the community, backed by new unique strands of thought
(biological psychology, biopsychiatry, etc). “We've fixed the
problem!”

Except...

“With
the new American Psychiatric Association Diagnostic and Statistical
Manual V (DSM V) slated for publication next year, leaders in
American psychiatry are criticizing the volume as unreliable.

The DSM is the compendium of conditions psychiatrists use to
diagnose their patients and, to a great extent, determine what
treatments would benefit them. The DSM also has extremely important
implications for what kinds of psychiatric problems insurers will
cover and even which ones schools and employers will consider
disabilities.
Dr. Allen Frances, professor emeritus at Duke University, who was
actually the chairman of the DSM-IV task force, asserts in a recent
blog published that the clinical trials that supposedly determined
whether the new DSM V is a good and accurate guide “have been a
pure disaster from start to finish.” He calls the trials a
“fiasco” and accuses the American Psychiatric Association of
having “lost its competence and credibility.”...”

Oh, yes. That's
right. This newest version is just as abhorrent as the DSM iterations
that came before, and now it's gotten to the point that leaders in
the community are challenging it. History has that tendency,
remember?, to repeat itself. Here it occurs again, but it's hard to
know the complete story of what you're seeing unless you know how to
look for it.

Albow continues:

“Frances is by no means the only
critic of the DSM-V. I have written before that advocates for those
with autism have expressed grave concerns that the new guidelines
proposed to diagnose that condition could leave out 10 to 45 percent
of those currently diagnosed with the condition, leading to millions
of children having no insurance coverage related to it.

But Frances alleges much more. He cites data that indicates that
the DSM V signs and symptoms that are proposed to define Major
Depression and Generalized Anxiety Disorder are unacceptably
inaccurate. And he worries that the official journal of the American
Psychiatric Association, the American Journal of Psychiatry,
which published a positive review of the DSM V has been “forced
into the role of a cheerleading house organ, not an independent
scientific journal.”
Given the concerns of leading psychiatrists like Frances, with
whom I happen to agree, it is time to give real consideration to
fundamentally changing the way psychiatrists use the DSM and
encouraging them to think much more about what caused the disorders
they are diagnosing.”

The
view from afar remains solid: the very pressures that created the
anti-Psychiatry movement in the first place are on the prowl again.
“We figured it out!” was the resounding cheer that lead to
dissent in the 1970s. It has returned with a resounding blast of
madness. Except that it isn't the patients that are mad in this case:
the community at large has been bought out, and evidence of it is
leaking all over the place.

Psychic Whiplash!

The
DSM and the way we handle patients are but one area where the focus
has gone out, and the reality of the situation remains beyond the
reach of current practitioners. But then again: I openly side with
their antagonistic, sometimes better-halves. Laing, for example, may
have been interesting and well intentioned, but he also made use of
Game Theory in his work, which was rather disastrous in the long run.

Another glaring
issue remains the drug companies, and how they are tampering with
trials and knowledge of the risks involved using their proposed
treatments. I covered this in the last round of my responses to
Gordon's Apocalypse Pharmaka entries. But I've spent some time really
considering the problem and decided that the only way to shed some
light on these factors is to return to the old view of Materia
Medica. The view was this,
until around the 1940s: All Medicines Are Poisons.
In small doses, with the right causes, those glorious secondary
metabolites in plants can help
us... Or kill us, in larger doses. The true genius of a doctor laid
in his ability to accurately balance the risks of medicine against
the possibility of leaving the problem untreated.

You
know that medicines are poisons because we would not have
side-effects without them. The side effect is a sign that what you're
taking is working, but
it's also a sign that too much will kill you. This is part of the
reason that I become some irate about the issue of “drugs.” Our
social dialogue on the matter sucks, and as a byproduct people have
bought into the narrative that what we're doing with medicine is
somehow good or wholesome. Let me assure you: it is not.

“In 1860 at a meeting of the
Massachusetts’ Medical Society Oliver Wendell Holmes made one of
the most celebrated comments in medicine. While noting that
medicines, particularly opium, could help, he nevertheless made it
plain that he thought that on balance medicines risked doing more
harm than good. You can’t be much plainer than this:

“I firmly believe that if the whole
materia medica, as now used, could be sunk to the bottom of
the sea, it would be better for mankind and all the worse for the
fishes”...”

The view we should
get away from is that we're discussing “drugs” at all. In fact,
we're discussing chemicals which affect the body, and which are often
poisons. (The other word, “toxin” is one I reserve for the more
deadly of the different secondary metabolites.) All of these
compounds are dangerous in some situations, but that danger lessens
in others. This includes your prescription drugs, and please take
that into account. Some compounds are less dangerous than others.

Yesterday,
two states voted to legalize pot. Meanwhile, the DEA
seems to be insisting they'll ignore these decisions. The
question that remains is whether or not we will return to some
semblance of sanity regarding what drugs are, where they come from,
and their legality versus illegality? Can we stray from the abyss
that opened up beneath us, question the narratives of past
generations, and move on? If I told you that by leveling the playing
field by adopting the old mentality with regards to materia
medica, we could take steps to
both end a century of prohibition and the corruption in the ranks of
some of our most celebrated fields of science and soft science, would
you believe me?

Regardless, I continue to desire
something better than the messes we currently have. What about you?

13 comments:

Good shrinks and therapists do exist. You have to shop around for them. Talk to 8 or 9 on the phone for 5 minutes (if they don't give you 5 minutes, eff them), and if you can have a pleasant, productive conversation, odds are they're decent people. Their trick is they use the DSM --- if they use the DSM, my therapist keeps hers at home and uses it for reference only --- as *their* and *your* tool, fitting the DSM's shite into the Procrustean bed of *your* needs.

That said, yeah, most psychologists and psychiatrists are quacks or demagogues. Either they're mere pill pushers or they attempt to impose their precious "therapeutic" agenda on you. These ones---don't walk, run away, even in mid session.

Good shrinks do exist. I don't wish to suggest that at all! What I wish to question is the narrative of effectiveness, and of understanding that existed in the last generation of Psych (and some future Psychiatry) students that I went to school with.

A lot of those guys? I really hope they never make it to practicing and having power over others. Swine, a whole ton of them.

I have a friend who is a psycho-therapist. Apparently the difference lies in that he has a masters degree, and not a medical degree. He uses cognitive behavioral methods to help people live better lives, although he works mostly with people getting out of prison, so they don't go back. A psychiatrist has a medical degree, and most studies neurochemistry, but not psychology. He maybe familiar with symptoms of mental disorders, but is not necessarily fully trained to diagnose it, compared to a therapist or psychologist. Most psychiatrists have not studied the methods of cognitive behavioral therapy or even basic psycho-anaylsis.

Psychologists are mostly academic or clinical. They run the drug tests, and tend to create other trials to watch behavior, abnormal behavior, and other signs of mental imbalance either from nature (ie chemical imbalances in the brain) or nurture (behaviors learned or altered because of exposure to events)

At least this is my understanding of the differences between the three groups.

Yesterday I saw an ad, I forgot who for or by, but it had to do with mapping your genetic sequence and now that drug companies are begining to move forward in creating genetically specific drugs for people, which will great increase thier effectiveness while aiming at diminishing the negative side effects. It was neat and chilling all at the same time.

@Bro. Chris: You're pretty much on par. Psychologists, even Psycho-Therapists, are trained primarily in psychology and have a soft science degree. Pyschiatrists have a hard science degree in medicine, so that they can directly work with medications.

Here in CA, though, those distinctions have been wittled down beyond the degrees by different laws we passed. We now allow General Practitioners of medicine to prescribe anti-depressants if they pass a rather stupidly easy test, and many psychologists can also begin the prescription process (although most have a Psychiatrist finish that treatment program).

I've not met a single Psychiatrist without at least a BS's worth of psychological training. I'm sure they exist, I've just yet to meet any.

I remember when I was in a high school psychology class. The teacher said no one really can define "crazy" any more than basically, if you can take care of yourself and don't harm yourself or others, you are basically sane.

When I was a kid (you know you are an old guy when you say that sort of thing a lot) when kids got hyper, you ran around outside and burned it off at recess. There wasn't an entire industry built around drugging basically high energy (aka "normal") kids. Of course our brains hadn't been rewired by constant exposure and stimulation to video games, computers, fast-edits MTV-style, etc. I can see the differences in generations very clearly.

At least half the young folks (20 and 30-something) in my classes are on some kind of prescriptions, mostly psychointeractive: ADHD, depression, etc. etc. Big Pharma and the Prison-Industrial Complex. Being crazy and then getting into trouble is one of the few "growth industries" left these days.

As for the various kinds of counselors, shrinks, etc. I took half-dozen psych courses as an undergrad when I was contemplating a major in it. Most the people in psych were there because they either thought they were messed up or they thought their families were. And the longer you are institutionalized, the more likely you will never get "better."

I just think about those high school days and wonder... as long as someone can take care of themselves (hold down a job, feed themselves, keep hygenic, get along with people most of the time) and not be danger to themselves or others, why do we have to push people on this stuff. Not everybody has to conform to some ideal according to the thought police.

on an off topic note,I was viewing my fb, and a friend had commented on a photo from a small business called "Poisoner's Apothecary." The photo was of newly poured "deodorant applicators" of witch's flying ointment. I was impressed and horrified all at the same time.

I totally agree. If the psychiatrist/psychologist had a Doctorate, they're usually worthless. My current shrink (I had to find one who was familiar with my, uh, new life issues) is not too bad. But mostly she just listens and is supportive and manipulates the system on my behalf. My therapist is actually able to offer good advice, good reframings --- I think that's NLP-speak ---, but only when I ask for them. Which is very cool. So avoid the Doctors of Whatever, unless you've very carefully screened them, and you'll be half way there. Then talk to bunches of Clinical Psychologists, if bunches are present in your area, and all just might be well. Except your bank account.

Your posts on the psych world are appreciated here, Faust. In line with the above advice, I'd certainly avoid the doctors. In some backwoods hell-holes, if you're without insurance, or even just lower class (if a child, you have no rights as to your treatment, as well), you might just end up a walking experiment. If you're special (read really unlucky), you may be unwittingly subject to it your entire life. It's a lot more fucked up than I'd suspect even you might realize. Maybe it's just the farther South you go. Ha.

Bro. Chris: I anticipate more flying Ointment/Powders/Elixirs as time goes on. I also anticipate some people getting fucked up by trusting folks who are new hands to the creation of them. It makes me deeply unhappy, but I don't think there's any real way to stop it at this point.

Although, that is a very clever way to apply and use them. Deodorant Applicators... Heh. I never even considered it.

Lance: When I was a teenager, I started to notice some of this and was deeply alarmed and unhappy. It only got worse, the older I became. I would agree with the BigPharma/BigPrison duo both being aspects of our culture that are out of control.

I am still not convinced that ADD/ADHD diagnoses are what the community at large claim them to be. I knew a kid who would spend something like 16+ hours reading, sometimes, who was diagnosed with ADD. He'd then bounce off the walls. No one ever considered encouraging him to, like, exercise before they put him on high-grade stimulants to "correct" his ADD.

F&I: You know, one thing I didn't say is that I know folks on all sides of this problem. I know some who got worse after seeking out "alternatives" to the psych world; I know some who got better. I know a few who the Psych world failed utterly and who didn't survive the process, and I know a few who were kept alive by their treatments (the latter of which I honestly appreciate). It's really hard for me to be general. A few of my former professors had really good handles on what they did - in both teaching and treatment. A few freaked me right the fuck out, etc.

I think that when you get involved with the community, it's easy to lose yourself to the internalized bias of certain narratives and to forget that BigPharma has begun warping the subject matter by failing to produce the scientific evidence that's necessary for individuals (Psychiatrists, Doctors, etc.) to actually understand the drugs we use and apply Empirical standards to those treatments. Secondarily, there has been a notable shift in treatments over the last 20 years favoring drugs above things like Psychologically therapeutic techniques. They still exist, of course, but they're normally done along with a battery of drugs (prescribed by a Psychiatrist) which are to create "breathing space" or "breathing room" (I'm pretty sure BigPharma created both of those concepts). So anyone seeking help should remember to look up their rights.

Alice: Howdy! Well, the problems exist in California, too. About a decade ago we passed laws allowing General Practitioners (e.g. Medical Doctors) to prescribe things like depression medication, and the rest of the nation has followed. I've actually seen plenty of abuse come from that arrangement. People were "diagnosed" with depression when they had Bipolar I or Bipolar II and turned into walking nightmares. I could go on, but it'll turn into a larger rant.

Then you have the newly trained former Students across the nation who have been pretty much raised up in a massive culture of over-medication and who fail to question the system. So I definitely consider the problem systemic. I can only imagine that issues revolving social control become worse as one heads South because areas of the South are obsessed with social control. Heh.

Do you mean something more, though? Do you think I'm missing some information? If so, I'd love to hear about it.